RENAL FAILURE

Introduction
 Sometimes kidneys are no longer able to filter and
clean blood.
 This can cause unsafe levels of waste products to
build up.
 This is known as kidney (or renal) failure.
 Unless it is treated, this can cause death.
 The kidneys are 2 bean-shaped organs, each about the
size of a fist.
 They are found in your back on either side of the
spine.
 Healthy kidneys clean waste products from the blood
by making urine.
 They also balance the number of certain elements in
the blood (such as sodium, potassium, and calcium),
and make hormones that control blood pressure and
red blood cells.
 Before kidney failure occurs, patients have "chronic
kidney disease" (CKD).
 Kidney (renal) failure is when kidneys don't work as
well as they should, to the point where kidney
replacement is required.
 Kidney replacement can be accomplished by different
kinds of dialysis or by kidney transplant.
 The term "kidney failure" covers a lot of problems.
 These problems can result in kidney failure:
 The kidney doesn't get enough blood to filter
 The kidney is hurt by a disease like
 high blood sugar (diabetes)
 high blood pressure
 glomerulonephritis (damage to the kidney's tiny
filters; one example: lupus)
 polycystic kidney disease
 and many others
 The kidney is blocked by a kidney stone or scar
tissue (blockage of ONE kidney usually does not cause
kidney failure because the other kidney is not affected;
but blockage of two kidneys can lead to an emergency).
Definition
 Kidney failure, also called renal failure, is when the
kidneys no longer work properly.
 The kidneys' main job is to clean the blood and make
urine (wee).
 When the kidneys do not work properly, waste and
fluid buildup in the body.
Kidney Cross Section
Types of Kidney Failure
There are two main types of kidney failure:
1. Acute kidney failure (also called acute renal failure,
or acute kidney injury)
2. Chronic kidney disease
Acute Kidney Failure
 Acute kidney failure is the short-term loss of kidney
function.
 It can develop quickly — over a few hours or days.
 It can be due to:
 an injury or illness — such as severe dehydration, or
an infection
 drugs or poisons
 In most cases, the kidney function will recover over
time — usually fairly quickly over a period of days.
  In other cases, acute kidney failure can cause
permanent damage and lead to chronic kidney
disease.
Characteristics of Acute Renal Failure
Acute kidney failure occurs when the kidneys
suddenly become unable to filter waste products from
the blood.
When the kidneys lose their filtering ability,
dangerous levels of wastes may accumulate, and the
blood's chemical makeup may get out of balance.
Acute kidney failure — also called acute renal failure
or acute kidney injury — develops rapidly, usually in
less than a few days.
Acute kidney failure is most common in people who
are already hospitalized, particularly in critically ill
people who need intensive care.
Acute kidney failure can be fatal and requires
intensive treatment.
However, acute kidney failure may be reversible.
If otherwise in good health, the patient may recover
normal or nearly normal kidney function.

Signs and Symptoms of Acute Kidney Failure

 Decreased urine output, although occasionally urine

output remains normal
  Fluid retention, causing swelling in the legs, ankles or
feet
 Shortness of breath
 Fatigue
 Confusion
 Nausea
 Weakness
 Irregular heartbeat
 Chest pain or pressure
 Seizures or coma in severe cases
NB: Sometimes acute kidney failure causes no signs or
symptoms and is detected through lab tests done for
another reason.

Chronic Kidney Failure

 Chronic kidney disease is when the kidneys have
been damaged in a way that can't be reversed.
 Chronic kidney disease takes months or years to
develop.
 If chronic kidney disease progresses, it can lead to
chronic kidney failure.
Signs and Symptoms of Chronic Kidney Disease include:
 hypertension (high blood pressure)
 night-time urination (weeing)
 changes in how the urine looks (such as frothy or
foamy)
 haematuria (blood in urine)
 oedema or puffiness (in the legs, ankles or around the
eyes)
 tiredness or weakness
 nausea (feeling sick) or vomiting
 itching
 restless legs
 breathlessness
Other Symptoms
 The symptoms of CKD are often quite mild; people
may have significantly reduced kidney function and
not be aware of it.
 The symptoms of kidney failure can differ based on
how bad the kidney failure is, how quickly it is getting
worse, and what is causing it.
 Noticing any of these symptoms is an indication to
see the doctor.

Causes of Kidney Failure

Causes of Acute Kidney Failure
Acute kidney failure can be caused by:
 damaged kidneys — due to disease, infections or
toxins
 dehydration
 trauma (physical damage) to the kidney — after
major surgery, or an accident
 blocked ureters (kidney drainage tubes) — this may
be from kidney stones, a tumour, or an
enlarged prostate
 some medicines
Causes of Chronic Kidney Failure
The most common conditions causing chronic kidney
failure are:
 diabetes
 high blood pressure
 inflammation in the kidney (glomerulonephritis)
When to See the Doctor
It's important to see the doctor if there are symptoms such
as:
 a build-up of fluid in the body
 the amount of urine made decreases.
Risk Factors
 Kidney disease often doesn't have any symptoms.
  It's sometimes called the 'silent disease'.
 But there are certain risk factors that can increase the
risk of chronic kidney disease.
 These include:
 hypertension (high blood pressure)
 smoking
 diabetes
 One who has chronic kidney disease should see the
doctor at least once a year.
 If there are risk factors for kidney disease, it's
important to get a regular Kidney Health Check.
 This involves 3 tests:
1. blood tests
2. urine tests
3. blood pressure test
 One who has diabetes or high blood pressure should
have a Kidney Health Check every year.
 If a smoker or have a family history of kidney disease
should have a Kidney Health Check every 2 years.
Diagnosis of Kidney Failure
Physical Examination for signs and symptoms and
health history.
Laboratory investigations/tests are recommended
such as:
  blood tests
 urine tests
 an ultrasound scan
Treatment of Kidney Failure
Treatment for kidney failure will depend on the type of
kidney failure and the cause.
Acute Kidney Failure
In acute kidney failure it includes:
 Investigate and treat the cause
 Prescribe medicine to help the kidneys recover
 Monitor the urine (wee) production and kidney
function
Some people will need short-term dialysis treatment to
help their kidneys recover.
Chronic Kidney Failure
There are 2 main treatment options for chronic kidney
failure:
1. Dialysis — removes waste and extra fluid from the
blood through either hemodialysis or peritoneal
dialysis.
2. Kidney Transplant — receive a healthy kidney from
a donor.
A dietitian should be seen for advice on the right diet to
follow and the right amount of fluid to drink.

A haemodialysis uses a machine to remove waste and

extra fluid from the blood.
 A
Dialysis using the abdomen to remove waste and extra
fluid from the body.

Prevention of Kidney Failure

 It's important to be aware of the risk factors — if
known to be at risk of kidney disease, one can have
the kidneys checked regularly.
 Most cases of chronic kidney disease are mild, and
treatment aims to stop the kidneys from deteriorating
(getting worse).
  In chronic kidney disease, medical treatments and
lifestyle changes can delay or prevent progression to
kidney failure.
 They can also help control symptoms.
 This might include things like:
 if a smoker — stop smoking
 controlling any high blood pressure
 controlling any diabetes
 treating any other conditions that may affect the
kidneys
 avoiding medicines that can affect the kidneys
Medicines that can Affect the Kidneys
With chronic kidney disease avoid the following:
 nonsteroidal anti-inflammatory drugs (NSAIDs),
such as ibuprofen and naproxen
 antacids which contain calcium
 high doses of vitamin C
Ask the doctor or pharmacist if unsure if a medicine is
safe to take.
Also check with them before taking:
 vitamins or supplements — they may contain
ingredients harmful to the kidneys
  herbal or complementary medicines — they may not
be suitable if in kidney disease or may interfere with
other medicines
Complications of Kidney Failure
In some people, acute kidney failure can cause
permanent damage.
This can put one at a higher risk of developing
chronic kidney disease.
Acute kidney failure can occur when:

 There is a condition that slows blood flow to the

kidneys
 There is an experience of direct damage to the kidneys
 The kidneys' urine drainage tubes (ureters) become
blocked and wastes can't leave the body through the
urine
Impaired blood flow to the kidneys

Diseases and conditions that may slow blood flow to the

kidneys and lead to kidney injury include:

 Blood or fluid loss

 Blood pressure medications
 Heart attack
  Heart disease
 Infection
 Liver failure
 Use of aspirin, ibuprofen (Advil, Motrin IB, others),
naproxen sodium (Aleve, others) or related drugs
 Severe allergic reaction (anaphylaxis)
 Severe burns
 Severe dehydration
Damage to the kidneys

These diseases, conditions and agents may damage the

kidneys and lead to acute kidney failure:

 Blood clots in the veins and arteries in and around the

kidneys
 Cholesterol deposits that block blood flow in the
kidneys
 Glomerulonephritis (gloe-mer-u-loe-nuh-FRY-tis),
inflammation of the tiny filters in the kidneys
(glomeruli)
 Hemolytic uremic syndrome, a condition that results
from premature destruction of red blood cells
 Infection, such as with the virus that causes
coronavirus disease 2019 (COVID-19)
  Lupus, an immune system disorder causing
glomerulonephritis
 Medications, such as certain chemotherapy drugs,
antibiotics and dyes used during imaging tests
 Scleroderma, a group of rare diseases affecting the
skin and connective tissues
 Thrombotic thrombocytopenic purpura, a rare blood
disorder
 Toxins, such as alcohol, heavy metals and cocaine
 Muscle tissue breakdown (rhabdomyolysis) that leads
to kidney damage caused by toxins from muscle tissue
destruction
 Breakdown of tumor cells (tumor lysis syndrome),
which leads to the release of toxins that can cause
kidney injury
Urine blockage in the kidneys

Diseases and conditions that block the passage of urine

out of the body (urinary obstructions) and can lead to
acute kidney injury include:

 Bladder cancer
 Blood clots in the urinary tract
 Cervical cancer
  Colon cancer
 Enlarged prostate
 Kidney stones
 Nerve damage involving the nerves that control the
bladder
 Prostate cancer

Risk factors

 Acute kidney failure almost always occurs in

connection with another medical condition or event.
 Conditions that can increase the risk of acute kidney
failure include:

 Being hospitalized, especially for a serious condition

that requires intensive care
 Advanced age
 Blockages in the blood vessels in the arms or legs
(peripheral artery disease)
 Diabetes
 High blood pressure
 Heart failure
 Kidney diseases
  Liver diseases
 Certain cancers and their treatments

Complications

Potential complications of acute kidney failure include:

 Fluid buildup. Acute kidney failure may lead to a

buildup of fluid in the lungs, which can cause
shortness of breath.
 Chest pain. If the lining that covers the heart
(pericardium) becomes inflamed, one may experience
chest pain.
 Muscle weakness. When the body's fluids and
electrolytes — the body's blood chemistry — are out
of balance, muscle weakness can result.
 Permanent kidney damage. Occasionally, acute
kidney failure causes permanent loss of kidney
function, or end-stage renal disease. People with end-
stage renal disease require either permanent dialysis
— a mechanical filtration process used to remove
toxins and wastes from the body — or a kidney
transplant to survive.
 Death. Acute kidney failure can lead to loss of kidney
function and, ultimately, death.
Prevention

Acute kidney failure is often difficult to predict or

prevent. But one may reduce the risk by taking care of the
kidneys. Try to:

 Pay attention to labels when taking over-the-

counter (OTC) pain medications.
Follow the instructions for OTC pain medications,
such as aspirin, acetaminophen (Tylenol, others),
ibuprofen (Advil, Motrin IB, others) and naproxen
sodium (Aleve, others). Taking too much of these
medications may increase the risk of kidney injury.
This is especially true if there is pre-existing kidney
disease, diabetes or high blood pressure.
 Work with the doctor to manage kidney and other
chronic conditions.
If there is kidney disease or another condition that
increases the risk of acute kidney failure, such as
diabetes or high blood pressure, stay on track with
treatment goals and follow doctor's recommendations
to manage the condition.
 Make a healthy lifestyle a priority. Be active; eat a
sensible, balanced diet; and drink alcohol only in
moderation — if at all.
Diagram of the Male and Female Urinary Tracts

Acute Kidney Injury (AKI)

There are 2 main types of kidney (renal)

failure: acute (sudden) and chronic (over time).

Acute Renal Failure – more commonly known today as

“acute kidney injury” (AKI)
AKI occurs when the kidneys suddenly stop filtering waste
products from the blood.

The signs of AKI can be:

 swelling of the hands, feet and face (edema)

 internal bleeding
 confusion
 seizures
 coma
 abnormal blood and urine tests
 high blood pressure
Chronic Kidney Disease (CKD; previously known as
Chronic Renal Failure – CRF)
CKD builds slowly with very few symptoms in its early
stages.

A patient with CKD may not have any symptoms until

kidney function declines to 20% or less. At that stage,
these signs may appear:

 abnormal blood and urine tests

 high blood pressure
 weight loss for no reason
 low red blood cell count (anemia)
 nausea
 vomiting
 metal taste in your mouth
 loss of appetite
 shortness of breath
 numbness and tingling
 confusion
 coma
 seizures
 easy bruising
 itching
 fatigue
 muscle twitches and cramps
 weak bones that break easily
 itching
 swelling of the hands, feet and face (edema)
 trouble sleeping
Causes
AKI is most likely to happen with:

 low blood flow (such as after complicated surgery or an

accident)
 swelling (inflammation) of the kidney (such as a
reaction to a drug or infection)
 sudden blockage (such as by a kidney stone)
 very high blood pressure
With AKI, the kidney often returns to normal or near
normal after the cause is treated.

CKD is permanent loss of kidney function. The most

common causes are:

 high blood pressure

 chronic glomerulonephritis (kidney damage)
 high blood sugar (diabetes)
 polycystic kidney disease
 blocked urinary tract
Diagnosis
 Overall kidney function is judged by the level of
filtration that occurs.
 Filtration is accomplished by the tiny blood vessels in
the kidney called “glomeruli”.
 So overall kidney function is called the “glomerular
filtration rate” (GFR), measured as the volume of
blood filtered per minute (milliters/minute).
 Normal values are about 100 ml/min, but varies with
age and sex.
  GFR can be estimated (eGFR) using formulas that
take into account your age, sex and a blood test called
creatinine.
 Kidney failure is most often found when the
creatinine level is high, indicating that kidney
function is reduced.
 Creatinine is a molecule made by the muscles.
 A normal kidney will remove creatinine from the
blood stream and get rid of it in urine.
 More creatinine in the blood is a sign that the kidneys
aren't cleaning the blood as well as they should.
 This test can spot something is wrong before a patient
with kidney failure feels sick.

Treatment
 To treat AKI, you have to treat the cause (such as
blood pressure that is too high or too low, a kidney
stone or high blood sugar).
 Sometimes you need dialysis for a short time.
 With CKD, treating the cause (such as high blood
pressure and/or high blood sugar) can slow the
disease.
 The goal is to prevent CKD from turning into
advanced kidney disease, or end stage kidney disease
(ESKD, formerly known as end stage renal disease,
ESRD).
  When kidney function falls below 10% of normal,
dialysis or a kidney transplant is usually needed,
especially if there are signs of uremia (a buildup of
waste in the blood), like nausea, loss of appetite,
weight loss and itching.

Dialysis
Dialysis is a way to remove extra salt, acid, potassium
and waste products from the blood.
The 2 types of dialysis are hemodialysis and
peritoneal dialysis.
Hemodialysis: For hemodialysis, a tube (catheter) is
stuck into one of the veins in the neck or leg.
Preferably, an access, or arteriovenous fistula, is
constructed in the arm.
Hemodialysis is most often done 3 times a week for 3
to 4 hours at a time.
Diagram of Hemodialysis Treatment

Peritoneal dialysis: Peritoneal dialysis is done through

a tube permanently set in the belly.
Fluid is then run into the abdomen, takes out the extra
salt and potassium and water, and then removed.
Most exchanges of fluid can be done by an automated
“exchanger” while asleep.
Most adults have dialysis done in an outpatient
hemodialysis center.
Most children have peritoneal dialysis done at home.
Peritoneal dialysis has a number of advantages and is
becoming more frequently used in adults in the US.

Kidney Transplant
 A kidney transplant is when a surgeon puts a healthier
kidney from another person into the body.
 Kidney transplant is the best way to treat many
patients with end stage kidney disease.
 Kidneys for transplant come from people who have
agreed to donate their kidneys when they die
(deceased donors) or donated by healthy people
(living donors).
 Living donors are most often family members of the
patient.
 There is a shorter wait time to surgery for a transplant
from a living donor.
 (This is because there is a waiting list for kidneys
from deceased donors and not enough donors.)
 Also, patients with kidneys donated by living donors
live longer (and the kidneys last longer) than those
with kidneys from deceased donors or who just stay
on dialysis.
 With modern medical techniques, the living kidney
donor doesn't need to be a blood family member to get
a good result.
 About 90,000 patients are on the wait list for deceased
donor kidney transplants in the U.S.
 But only 10,000 deceased donor kidney transplants
are done each year due to the lack of donated kidneys.
 Another 6,000 kidney transplants are done each year
from living kidney donors.